1. Professional Information

Karen Wise, LPC
Licensed Professional Counselor #2650
Karen Wise Counseling
1532 N. Emerson Street, Suite 302,
Denver, CO 80218
karenwisecounseling.com
720-231-2459

2. Levels of Regulation of Mental Health Professionals in Colorado

-A Registered Psychotherapist is a psychotherapist listed in the State’s database and is authorized by law to practice psychotherapy in Colorado, but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state.
- A Certified Addiction Counselor I (CAC I) must be a high school graduate or equivalent, complete required training hours and 1,000 hours of supervised experience.
- A Certified Addiction Counselor II (CAC II) must be a high school graduate or equivalent, complete the CAC I requirements, and obtain additional required training hours, 2,000 additional hours of supervised experience, and pass a national exam.
- A Certified Addiction Counselor III (CAC III) must have a bachelor’s degree in behavioral health, complete CAC II requirements, and complete additional required training hours, 2,000 additional hours of supervised experience, and pass a national exam.
- A Licensed Addiction Counselor must have a clinical master’s degree, meet the CAC III requirements, and pass a national exam.
- A Licensed Social Worker must hold a master’s degree from a graduate school of social work and pass an examination in social work.
- A Licensed Clinical Social Worker must hold a master’s or doctorate degree from a graduate school of social work, practiced as a social worker for at least two years, and pass an examination in social work.
-A Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure.
- A Licensed Marriage and Family Therapist must hold a master’s or doctoral degree in marriage and family counseling, have at least two years post-master’s or one year post-doctoral practice, and pass an exam in marriage and family therapy.
- A Licensed Professional Counselor must hold a master’s or doctoral degree in professional counseling, have at least two years post-master’s or one year postdoctoral practice, and pass an exam in in professional counseling.
- A Licensed Psychologist must hold a doctorate degree in psychology, have one year of post-doctoral supervision, and pass an examination in psychology.

3. Degrees, Credentials, and Licensure

Karen Wise, LPC
Master of Science in Counseling, Southern Illinois University Carbondale Licensed Professional Counselor, State of Colorado (License #2650)

4. Professional Regulation

The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Professions and Occupations.

The Board of Licensed Professional Counselor Examiners can be reached at:
1560 Broadway, Suite 1350 Denver, CO 80202
Phone: (303) 894-7800

5. Information About Therapy

You are entitled to receive information about the methods of therapy, the techniques used, the duration of therapy, if known, and the fee structure.

6. Client Rights

You may seek a second opinion from another therapist or may terminate therapy at any time.

7. Professional Boundaries

In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant, or certificate holder.

8. Confidentiality

Generally speaking, the information provided by and to the client during therapy sessions is legally confidential and cannot be released without the client's consent. There are exceptions to this confidentiality, some of which are listed in § 12-245-220, C.R.S., and other exceptions in Colorado and federal law. If a legal exception arises during therapy, you will be informed accordingly.

Client Acknowledgment

I have read and understand this Colorado Mandatory Disclosure Statement. I have had the opportunity to ask questions regarding this information.

Professional Fees
The fee for a standard 50-minute counseling session is $200.00.

If a longer session is requested or clinically appropriate, fees will be prorated based on the length of the session unless otherwise agreed upon in advance.

Ketamine-Assisted Psychotherapy (KAP) Sessions
Ketamine-Assisted Psychotherapy (KAP) sessions are scheduled separately from standard counseling appointments.

The fee for a KAP session is $400.00 and includes up to two (2) hours of psychotherapy.

The fee reflects the time reserved exclusively for your appointment, the specialized nature of KAP, clinical monitoring during the session, and the therapist's professional expertise. The full session fee applies even if the session concludes before the full two-hour appointment time.

If a KAP session extends beyond the scheduled two-hour appointment, additional time may be billed at my current professional rate, prorated according to the additional time required.

Preparation sessions and integration sessions are scheduled separately and billed at my standard counseling fee unless otherwise discussed in advance.

Payment

If payment cannot be made at the time of the appointment, please discuss this with me in advance so that alternative arrangements may be considered.

Accepted forms of payment include:

● Zelle (preferred)
● Credit or debit card
● Health Savings Account (HSA) card
● Flexible Spending Account (FSA) card (if applicable)
● Venmo

Personal checks are not accepted.

Private Pay Practice

Karen Wise, MS, LPC is a private-pay practice.

Upon request, I am happy to provide a Superbill for clients who wish to seek possible out-of-network reimbursement from their insurance carrier.

Please note that reimbursement is determined solely by your insurance company. Clients are responsible for payment of all fees regardless of whether reimbursement is received.

Cancellation Policy

Appointments represent time reserved specifically for you.

If you need to cancel or reschedule an appointment, please provide at
least 24 business hours' notice.

Appointments cancelled with less than 24 business hours' notice and
missed appointments ("no-shows") will be charged the full session fee.

Outstanding Balances

Payment is expected at the time services are provided.

If an account has an outstanding balance, future appointments may be postponed until the balance has been paid.

Extended Professional Services

Routine administrative communication related to scheduling is provided without charge.

Professional services requested outside of scheduled counseling sessions—including report writing, professional letters, treatment summaries, consultation with other professionals (when authorized), telephone consultations exceeding 10 minutes, or other services outside of regularly scheduled appointments—may be billed at my current professional rate, prorated according to the time required.

Whenever possible, you will be informed of any applicable charges before these services are provided.

Court-Related Services

Karen Wise, MS, LPC does not provide forensic evaluations or expert witness services as part of routine counseling.

If you request records, treatment summaries, letters, or other documentation for legal or administrative purposes, fees may apply based on the time required to prepare those materials.

Collection of Outstanding Accounts

Every effort will be made to resolve unpaid balances directly.

If an account remains unpaid despite reasonable efforts to collect payment, Karen Wise Counseling reserves the right to pursue collection of outstanding balances through appropriate legal or collection procedures, consistent with applicable law.

Good Faith Estimate

Under the federal No Surprises Act, clients who are not using insurance have the right to receive a Good Faith Estimate explaining the expected cost of counseling services.

A separate Good Faith Estimate will be provided in accordance with federal law.

Questions

If you have questions regarding this Financial Policy or any fees associated with your care, please ask before signing below.

Client Acknowledgment

I acknowledge that I have read and understand the Financial Policy of Karen Wise Counseling. I agree to be financially responsible for services provided under the terms described above.

THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION ("PHI") MAY BE USED AND DISCLOSED, YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION, AND HOW YOU MAY OBTAIN ACCESS TO THAT INFORMATION. PLEASE READ THIS NOTICE CAREFULLY.

My Commitment to Your Privacy

Karen Wise, MS, LPC is committed to protecting the privacy and confidentiality of your Protected Health Information ("PHI"). Federal law requires me to maintain the privacy of your PHI, provide you with this Notice of Privacy Practices, and abide by its terms.

Protected Health Information includes information created or received while providing counseling services that identifies you and relates to your past, present, or future physical or mental health, the healthcare services you receive, or payment for those services.

How Your Protected Health Information May Be Used and Disclosed

Treatment

Your Protected Health Information may be used and disclosed to provide counseling services, develop treatment plans, coordinate your care with other healthcare providers (when appropriate and authorized), maintain your clinical record, and obtain professional consultation when appropriate.

Payment

Your Protected Health Information may be used to obtain payment for services provided or to prepare Superbills or other documentation you request for possible insurance reimbursement.

Health Care Operations

Your Protected Health Information may be used for activities necessary to operate this practice, including quality assurance, professional consultation, licensing compliance, and administrative functions.

Whenever practical, only the minimum necessary information will be used or disclosed.

Uses and Disclosures Requiring Your Written Authorization

Except as otherwise permitted or required by law, your written authorization is required before your Protected Health Information is released to another person or organization.

You may revoke your authorization at any time by providing written notice. Revocation will not affect any action already taken in reliance upon your authorization.

Uses and Disclosures Permitted or Required by Law

Federal and Colorado law permit or require disclosure of your Protected Health Information without your authorization in certain circumstances, including, but not limited to:

●  Reporting suspected child abuse or neglect.
●  Reporting abuse, neglect, or exploitation of an at-risk adult.
●  Responding to court orders or other lawful legal proceedings.
●  Preventing or reducing a serious and imminent threat to the health or safety of you or another person.
●  Public health reporting requirements.
● Health oversight activities.
● Certain law enforcement purposes.
● Workers' compensation claims when required by law.

Whenever appropriate and clinically feasible, and when permitted by law, I will discuss these disclosures with you before they are made. If advance discussion is not possible or appropriate, I will discuss the disclosure with you afterward whenever feasible.

Making a report required by law does not mean that abuse, neglect, or other allegations have been substantiated. The purpose of such reports is to allow the appropriate governmental agency to determine whether further assessment or investigation is necessary.

Confidentiality When Working with Minors

When counseling a minor, I strive to create a therapeutic environment in which the minor feels safe discussing personal concerns. Depending upon the minor's age, maturity, and applicable Colorado law, certain counseling services may be provided with a greater degree of confidentiality.

Parents and legal guardians generally play an important role in a minor's treatment, consistent with applicable Colorado law regarding a minor's confidentiality rights.

However, confidentiality has important legal and ethical limits. If I have reasonable suspicion that a child has been abused or neglected, or if I believe disclosure is otherwise required by law to protect the safety of the client or another person, I am legally and ethically required to make the appropriate report or disclosure. In those situations, I will disclose only the information reasonably necessary to comply with my legal obligations.

Your Rights Regarding Your Protected Health Information

You have the right to:

●  Inspect and obtain a copy of your clinical record, as permitted by law.
●  Request an amendment to your health record if you believe information is inaccurate or incomplete.
●  Request restrictions on certain uses or disclosures of your Protected Health Information.
●  Request confidential communications by alternative means or at alternative locations.
●  Receive an accounting of certain disclosures of your Protected Health Information, as permitted by law.
●  Obtain a paper copy of this Notice, even if you previously received it electronically.

Certain requests may be denied when permitted by applicable law. If a request is denied, you will receive information regarding your right to request a review of that decision, if applicable.

Electronic Communication

Although reasonable safeguards are used to protect your privacy, email and text messaging are not completely secure methods of communication.

Electronic communication should generally be limited to scheduling or administrative matters rather than the exchange of sensitive clinical information.

My Legal Responsibilities

Karen Wise, MS, LPC is required by law to:

● Maintain the privacy of your Protected Health Information.
● Provide you with this Notice of Privacy Practices.
● Abide by the terms of the Notice currently in effect.
● Notify you if a breach of your unsecured Protected Health Information occurs when required by law.

Changes to This Notice

Karen Wise, MS, LPC reserves the right to revise this Notice of Privacy Practices at any time as permitted by law.

Any revised Notice will apply to all Protected Health Information maintained by this practice. The most current version will be available upon request and on the practice website.

Questions or Complaints

If you have questions regarding this Notice or believe your privacy rights have been violated, you may contact:

Karen Wise, MS, LPC
Licensed Professional Counselor #2650
1532 N. Emerson Street, Suite 302
Denver, CO 80218
(720) 231-2459

A complaint may also be filed through the Office for Civil Rights or by contacting the appropriate regional Office for Civil Rights.

If you have concerns regarding my professional conduct as a Licensed Professional Counselor, you may also contact:

Colorado Division of Professions and Occupations

State Board of Licensed Professional Counselor Examiners
1560 Broadway, Suite 1350
Denver, CO 80202
(303) 894-7800

(Revised July 2026)

Acknowledgment of Receipt of Notice of Privacy Practices

I acknowledge that I have received a copy of the Karen Wise, MS, LPC Notice of Privacy Practices. I understand that this Notice explains how my protected health information may be used and disclosed and describes my rights under the Health Insurance Portability and Accountability Act (HIPAA).

My signature acknowledges only that I received the Notice of Privacy Practices. My signature does not indicate that I agree with every provision contained in the Notice.

_______________________________

Purpose of Telehealth Services

Telehealth allows counseling services to be provided through secure electronic communication technology when you and your counselor are in different locations.

Telehealth may be used when it is clinically appropriate and agreed upon by both the client and the counselor.

Nature of Telehealth

Telehealth services are intended to provide counseling that is comparable to in-person services whenever clinically appropriate. However, because services are provided electronically, there may be limitations that do not exist during face-to-face sessions.

Benefits of Telehealth

Potential benefits include:

●  Increased access to counseling services.
●  Greater convenience.
●  Reduced travel time.
●  Continuity of care when travel or other circumstances prevent in-person appointments.

Risks of Telehealth

Potential risks include, but are not limited to:

●  Technical failures or interruptions.
●  Reduced quality of audio or video communication.
●  Unauthorized access despite reasonable security safeguards.
●  Delays in communication caused by technology failures.
●  Limitations in the counselor's ability to observe certain nonverbal behaviors.

Although reasonable efforts are made to protect the confidentiality of electronic communications, absolute confidentiality cannot be guaranteed.

Technology Requirements

Clients are responsible for:

● Using a private location whenever possible.
● Protecting the confidentiality of their environment.
● Using a reliable internet connection and appropriate technology.
● Minimizing interruptions during the counseling session.

For confidentiality and safety, the use of public Wi-Fi networks is discouraged.

Client Location

At the beginning of each telehealth session, you may be asked to provide:

● Your current physicall ocation (address or location).
● A telephone number where you can be reached during the session.
● An emergency contact, if clinically appropriate.

This information is necessary in the event emergency services must be contacted.

Emergency Situations

Telehealth is not appropriate for emergency or crisis situations.

If you are experiencing a mental health emergency or believe you may be at immediate risk of harming yourself or another person, call 911, go to the nearest emergency department, or contact the 988 Suicide & Crisis Lifeline by calling or texting 988.

Technical Difficulties

If the video connection is interrupted, reasonable efforts will be made to reconnect.

If reconnection is unsuccessful, the session may continue by telephone when clinically appropriate or be rescheduled.

Confidentiality

Confidentiality during telehealth counseling is subject to the same legal and ethical standards that apply to in-person counseling.

Please refer to the Colorado Mandatory Disclosure Statement and the Notice of Privacy Practices for additional information regarding confidentiality and its legal limitations.

Recording

Audio or video recording of counseling sessions by either the client or the counselor is not permitted without the prior written consent of all participants.

Right to Withdraw Consent

You may withdraw your consent to receive telehealth services at any time.
Withdrawal of consent will not affect your right to receive in-person counseling when clinically appropriate and available.

Karen Wise, LPC, also reserves the right to recommend in-person counseling or referral if telehealth is no longer clinically appropriate.

Client Acknowledgment

By signing below, I acknowledge that:

●  I have read and understand this Telehealth Informed Consent.
●  I have had the opportunity to ask questions regarding telehealth services.
●  My questions have been answered to my satisfaction.
●  I understand the benefits and potential risk sassociated with telehealth counseling.
●  I voluntarily consent to participate in counseling services through telehealth.

 

THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION ("PHI") MAY BE USED AND DISCLOSED, YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION, AND HOW YOU MAY OBTAIN ACCESS TO THAT INFORMATION. PLEASE READ THIS NOTICE CAREFULLY.

My Commitment to Your Privacy

Karen Wise, MS, LPC is committed to protecting the privacy and confidentiality of your Protected Health Information ("PHI"). Federal law requires me to maintain the privacy of your PHI, provide you with this Notice of Privacy Practices, and abide by its terms.

Protected Health Information includes information created or received while providing counseling services that identifies you and relates to your past, present, or future physical or mental health, the healthcare services you receive, or payment for those services.

How Your Protected Health Information May Be Used and Disclosed

Treatment

Your Protected Health Information may be used and disclosed to provide counseling services, develop treatment plans, coordinate your care with other healthcare providers (when appropriate and authorized), and maintain your clinical record.

Payment

Your Protected Health Information may be used to obtain payment for services provided or to prepare Superbills or other documentation you request for possible insurance reimbursement.

Health Care Operations

Your Protected Health Information may be used for activities necessary to operate this practice, including quality assurance, professional consultation, licensing compliance, and administrative functions.

Whenever practical, only the minimum necessary information will be used or disclosed.

Uses and Disclosures Requiring Your Written Authorization

Except as otherwise permitted or required by law, your written authorization is required before your Protected Health Information is released to another person or organization.

You may revoke your authorization at any time by providing written notice. Revocation will not affect any action already taken in reliance upon your authorization.

Uses and Disclosures Permitted or Required by Law

Federal and Colorado law permit or require disclosure of your Protected Health Information without your authorization in certain circumstances, including, but not limited to:

●  Reporting suspected child abuse or neglect.
●  Reporting abuse, neglect, or exploitation of an at-risk adult.
●  Responding to court orders or other lawful legal proceedings.
●  Preventing or reducing a serious and imminent threat to the health or safety of you or another person.
●  Public health reporting requirements.
● Health oversight activities.
● Certain law enforcement purposes.
● Workers' compensation claims when required by law.

Whenever appropriate and permitted by law, I will discuss these disclosures with you.

Your Rights Regarding Your Protected Health Information

You have the right to:

●  Inspect and obtain a copy of your clinical record, as permitted by law.
●  Request an amendment to your health record if you believe information is inaccurate or incomplete.
●  Request restrictions on certain uses or disclosures of your Protected Health Information.
●  Request confidential communications by alternative means or at alternative locations.
●  Receive an accounting of certain disclosures of your Protected Health Information, as permitted by law.
●  Obtain a paper copy of this Notice, even if you previously received it electronically.

Certain requests may be denied when permitted by applicable law. If a request is denied, you will receive information regarding your right to request a review of that decision, if applicable.

Electronic Communication

Although reasonable safeguards are used to protect your privacy, email and text messaging are not completely secure methods of communication.

Electronic communication should generally be limited to scheduling or administrative matters rather than the exchange of sensitive clinical information.

My Legal Responsibilities

Karen Wise, MS, LPC is required by law to:

●  Maintain the privacy of your Protected Health Information.
●  Provide you with this Notice of Privacy Practices.
●  Abide by the terms of the Notice currently ineffect.
●  Notify you if a breach of your unsecured Protected Health Information occurs when required by law.

Changes to This Notice

Karen Wise, MS, LPC reserves the right to revise this Notice of Privacy Practices at any time as permitted by law.

Any revised Notice will apply to all Protected Health Information maintained by this practice. The most current version will be available upon request and on the practice website.

Questions or Complaints

If you have questions regarding this Notice or believe your privacy rights have been violated, you may contact:

Karen Wise, MS, LPC
Licensed Professional Counselor #2650
1532 N. Emerson Street, Suite 302 Denver, CO 80218
(720) 231-2459
karenwisecounseling.com

A complaint may also be filed through the Office for Civil Rights Complaint Portal or by contacting the appropriate regional Office for Civil Rights.

If you have concerns regarding my professional conduct as a Licensed Professional Counselor, you may also contact:

Colorado Division of Professions and Occupations
State Board of Licensed Professional Counselor Examiners
1560 Broadway, Suite 1350
Denver, CO 80202
(303) 894-7800

(Revised July 2026)

Acknowledgment of Receipt of Notice of Privacy Practices

I acknowledge that I have received a copy of the Karen Wise, MS, LPC Notice of Privacy Practices. I understand that this Notice explains how my protected health information may be used and disclosed and describes my rights under the Health Insurance Portability and Accountability Act (HIPAA).

My signature acknowledges only that I received the Notice of Privacy Practices. My signature does not indicate that I agree with every provision contained in the Notice.